IMF RAW Run Leader Personal Information Form

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IMF RAW RUN LEADERS

Personal Information

All IMF RAW Run Leaders must complete the Run Leader Personal Information form, which acknowledges and accepts the terms of the IMF RAW Code of Conduct.

"*" indicates required fields

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This field is for validation purposes and should be left unchanged.

RAW Community*

Full Name*

As shown on your photo ID.

Preferred Name

Address*

State*

Email*

Phone Number*

Date of Birth*

Gender*

ABOUT YOU

I AM:*

My mob/tribe/country is:*

Shirt Size*

Shoe Size (US)*

Medical Information

Do you have any physical, medical or intellectual impairment that may affect your ability to coach?*

If Yes, please list any current or pre-existing medical conditions you have.*

Do you have any current or pre-existing sports injuries?*

If Yes, please list any current/recurring injuries.*

Accreditation and Experience

What accreditation have you complete below?

Community Run Leader*

Level 1 - Date Completed

Level 2 - Date Completed

First Aid & CPR*

First Aid Expiry Date*

CPR Expiry Date*

Upload copy of your First Aid Certificate here:*

Max. file size: 256 MB.

Upload copy of your CPR Certificate here (if renewed after original certification):

Max. file size: 256 MB.

First Aid Expiry Date*

Upload copy of your First Aid Certificate here:*

Max. file size: 256 MB.

Working with Vulnerable People / Children card*

If you hold a WWVP card in more than one state please list your home state here and add the additional details in the 'Other relevant experience' section below. If you do not hold a current WWVP please apply for one today. You can find links to each of the states in the Run Leaders Portal - Run Leader Accreditation section. Provide evidence of your application in the Upload section below.

State Issued*

Card Number*

Expiry Date*

Upload copy of your WWVP card or evidence of your application (confirmation email) here:*

Max. file size: 256 MB.

Link Working with Vulnerable People / Children card to Orgranisation*

If you hold a WWVP card it needs to be linked to IMF. Please access the relevant form for your state from the Run Leaders Portal and upload the completed and signed form here.

Upload Link WWP to Organisation form here:

Max. file size: 256 MB.

Your current job role/position and professional background.*

Other relevant experience, qualifications and/or certificate relevant to health, fitness, education, and coaching.

Run Leader Profile Image

Max. file size: 256 MB.

Upload an image of yourself to be included on the Run Leaders Website Portal. We will contact you for consent for any further use.

Signature*

Date*

IMF RAW RUN LEADERS

Personal Information

ABOUT YOU

Medical Information

Accreditation and Experience

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